Tracheomalacia

Tracheomalacia is a condition where the tracheal walls are weak or floppy, causing the trachea to collapse—especially during exhalation, coughing, or crying. This leads to airway obstruction, noisy breathing, and other respiratory symptoms.

🧬 What Happens in Tracheomalacia?

The cartilage rings in the trachea, which normally keep it open, are either underdeveloped (congenital) or become weakened (acquired). This causes:

• Airway collapse during expiration (when pressure inside the chest is high)
• Airflow limitation, especially when increased breathing effort is needed

🧒🧑 Types of Tracheomalacia

1. Congenital Tracheomalacia

• Present at birth
• May occur alone or with other anomalies (e.g., tracheoesophageal fistula, esophageal atresia)
• Often improves with age as cartilage stiffens

2. Acquired Tracheomalacia

• Occurs later due to:
  • Prolonged intubation or tracheostomy
  • Infections
  • Chronic inflammation (e.g., from GERD, tracheitis)
  • External compression (e.g., tumors, vascular rings)
  • Relapsing polychondritis (autoimmune)

📋 Symptoms

• Noisy breathing (especially during exhalation)
• Stridor or wheezing that doesn’t respond to asthma meds
• Chronic cough
• Frequent respiratory infections
• Difficulty breathing, especially when crying, coughing, or feeding (in infants)
• Cyanosis (blue skin/lips) in severe cases

🧪 Diagnosis

• Flexible bronchoscopy – gold standard; visualizes dynamic collapse of airway
• CT scan with dynamic expiratory imaging – shows narrowing of tracheal lumen
• Fluoroscopy – for dynamic airway assessment
• Pulmonary function tests (in older children/adults)

💊 Treatment Options

✅ Mild Cases (especially congenital):

• Often improve with age
• Supportive care: humidified air, chest physiotherapy, careful monitoring
• Manage GERD if present

🩺 Moderate to Severe Cases:

• CPAP or BiPAP – keeps airway open during breathing
• Tracheostomy – for airway support (in severe cases)
• Aortopexy – surgical procedure to relieve airway compression
• Tracheal stenting – used in selected adult cases (risks include infection, granulation tissue)

🛡️ Prognosis

• Congenital tracheomalacia often improves by 18–24 months
• Acquired cases depend on cause and response to treatment
• Long-term issues possible if severe or associated with other conditions

🧠 Important Distinctions